Ageing successfully

Couple on Beach

According to the World Health Organization (WHO), life expectancy and medical advances has lengthened lifespans in most countries, and the number of people aged 60 years and older has doubled since 1980. Living longer is easy, with the advances we’re making in the domain of science and medicine. But we’re probably more interested in answering the question of how we can age successfully. That and avoiding dementia.

On this International Day of Older Persons, let’s review what’s been known for a while:

1. Eat your veggies!

There’s no getting away from it. Studies show that those who live a long independent life in Okinawa eat lots of fruits and vegetables, as well as fish and whole-grains. Their habit of eating until they feel 80% full is also likely a major contributor to the reason for their disability-free longevity.

2. Stay active!

Research indicates that cardiovascular disease risk is a major contributor to Alzheimer’s and vascular dementia (Fratiglioni et al., 2004). Lowering this risk through regular, weekly moderate-to-vigorous exercise is one strategy. And also a reason why Sardinians, who herd sheep over steep hills, are reputed to age successfully (see this TED video about the blue zones).

3. Engage your social brain!

A review of the literature shows that adults who are socially active are also likely to have better psychological wellbeing in their later years; being engaged in social activities and having stronger social networks is a protective factor against dementia (Fratiglioni et al., 2004). Various studies show that religious attendance, community involvement, and being employed are associated with better mental wellbeing among older adults. These activities are also shown to be helpful for local residents too…

So to sum, it’s the same thing that us active younger (a little bit younger) adults need to start doing. But we just need to keep doing them!

Caregiving: It’s a thankful job

World Elder Abuse Day

The World Health Organization defines dementia as a syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities. It is not considered part of normal ageing, but affects a substantial number of older adults. The Statistical Appendix from the local Alzheimer’s Disease Association put the number of locals with dementia at 22 for every 1000 persons in the year of 2005.

The multidimensional response to the negative appraisal and perceived stress resulting from taking care of an ill individual (Kim et al., 2011) does however negatively affect those tasked with looking after the care recipient. This caregiver burden puts strain and stress particularly on those in full or part-time employment.

And caregivers aren’t necessarily only those who do this job fulltime. There are more caregivers out there than you think. A 2011 Singstat Singapore Newsletter article reports that almost 75% of respondents providing regular assistance to friends or family in 2010 were also working adults who juggle work with caregiving responsibilities.

Given that research has shown that caregiver stress increases with the physical dependency of the care receipient, it’s all the more important that caregivers are equipped with the right knowledge. Kua and Tan in a 1997 study (see also Mehta, 2005) found that those who looked after care receipients with dementia tended to experience a high level of stress. And according to WHO, this is a pattern observed in other communities as well.

But the mental health of caregivers is often overlooked. Although various organisations like the US Family Caregiver AllianceTouch Caregivers, Singapore Caregiving Welfare Association, Women’s Initiative for Ageing Successfully, Council for the Third Age, Asian Women’s Welfare Association, Tsao Foundation and Singapore Family Caregivers, have useful self-care tips, caregivers typically do not seek help for themselves.

So we may need to play our part and help someone we know and care about. The American Psychological Association (APA) suggests a self-assessment instrument which was designed by the American Medical Association.

So on this World Elder Abuse Awareness Day, help that person you know take a step in the right direction. Get him or her to assess his or her stress levels, which will ultimately protect himself or herself from being burnt out as a caregiver!

Signs of cognitive decline that we should worry about

Aging successfully

It was recently reported that tip-of-the-tongue phenomena isn’t something that we need to worry excessively about.

It appears that older people have the experience of not being able to identify someone famous or find the name of something more frequently than younger people (“Tip-of-the-Tongue Moments May be Benign“, American Psychological Science, 16 Oct 2013). But it has been found to be unrelated to cognitive changes associated with onset of dementia, suggesting that we shouldn’t be too concerned when we can’t name an actor in the midst of our frenetic discussion of the current k-drama series during family reunion dinners.

In contrast, there are other signs which we should be paying attention to. The Agency for Healthcare Research and Quality (US) for example lists a number of symptoms which might indicate dementia, which include experiencing increased difficulty remembering recent conversations and appointments, performing complex tasks which involve a number of steps, orienting and finding one’s way to familiar places. The Alzheimer’s Association (US) lists 10 symptoms which distinguishes the signs that someone may have Alzheimer’s from that of typical age-related cognitive changes. Given that dementia is a progressive condition, where there is “deterioration in memory, thinking, behaviour and the ability to perform everyday activities” (WHO), these early stage signs serve as a useful guide. The tendency to confuse time and place, resulting in one going to an appointment at the wrong time or at the wrong place, is another such sign – mentioned here by the Health Promotion Board.

There is also much talk about a scan which may determine if one’s cognitive difficulties are caused by Alzheimer’s disease (“Alzheimer’s Anxiety“, NY Times, 16 Nov 2013). But perhaps more pressing for most of us is the issue of whether we’re experiencing cognitive difficulties which warrant a closer look. And the answer to that might just be in a 12-question pen-and-paper questionnaire (known as the SAGE) which has been found useful for discerning cognitive decline, and for which validity research findings were recently published in the Journal of Neuropsychiatry and Clinical Neurosciences and reported in this article in Forbes (14 Jan 2014).

Autism: Facts and Tips

autism updates

Autism is a developmental disorder which leads to difficulties with verbal and nonverbal communication, with social interactions, and with understanding and predicting other people’s intentions and behaviours. On this Autism Awareness Day, it’s important that we know the facts:

1. The cause for autism is as yet unknown.

2. Not everyone who has autism has a special talent like that of Raymond in Rain Man (1988).

3. Autism can be diagnosed in early childhood. 

4. More boys than girls are diagnosed with autism.

5. There are support groups for families of individuals with autism.

6. It’s important for parents to receive emotional support as well.

10 Things To Know About Caregiving

The current ratio of adults aged 20 to 64 years to older adults aged 65 years and above is 6.4, according to the Department of Statistics Singapore, although a recent news article (“Fast-ageing Singapore, fewer to support aged; Trend worries experts”, The Sunday Times, 27 Sept 2013) put this figure at 5.5. Concerns about an ageing demographic aren’t solely a local concern. According to the facts and figures from WHO, life expectancy and medical advances make this issue in other countries too.

It should be pointed out that its entirely arbitrary that we should support someone at age 65 but not the year before. But nevertheless, ageing is a pressing issue. Consequently, ageing issues receive much media attention, with recent special reports such as those listed below, putting the spotlight on caregivers.

While it’s reassuring to know that one isn’t alone in the sandwich generation of being a parent of young (and not-so-young) children and being a caregiver of parents (and for some, siblings), it may be useful to have the resources one needs or will eventually need, when caregiving needs arise.

As full-time employees, we may be only part-time caregivers, but we are still caregivers in some capacity or other nonetheless. Given that the mental wellbeing of caregivers is important, here’s 10 things you should know about caregiving:

  1. Most caregivers in Singapore are employed. You’re not alone.

    According to a 2010 survey, almost 75% of individuals who said they provided regular assistance to friends or family were employed (Singstat Singapore Newsletter, Sept 2011). That means that many caregivers endeavor to manage their time between work, caregiving and others responsibilities at the home.

  2. Caregivers may experience high levels of stress.

    Research shows that caregiver stress increases with the physical dependency of the care receipient. As reported in a 2007 NCSS Social Service Journal, research shows that care receipients who have lower scores on Activities of Daily Living tend to have caregivers who experience higher levels of stress (Mehta & Joshi, 2001). Specifically, those who look after care receipients who have dementia tend to have high levels of stress (Kua & Tan, 1997). Don’t be surprised when this turns up as one of the WHO’s 10 Facts About Dementia!

  3. There are many resources available for caregivers. Several local organizations also have online caregiving resources.

    These include among others: a fact sheet about dementia (WHO), the 10 early warning signs (Alzheimer’s Association), books on coping with caregiver emotions and stress from the US National Institute of Aging, useful tips and facts for caregivers from the US Family Caregiver Alliance. 

  4. Touch Caregivers Support

    Touch Caregivers Support provides useful Caregiver Tips, runs courses and talks, and counselling services. Their website also has resources in Chinese.

  5. Caregiving Welfare Association

    The Caregiving Welfare Association has an free online counselling service for caregivers providing care to older adults with physical or mental disabilities, where caregivers are residents of Singapore and above 18 years of age.

  6. WINGS

    WINGS organizes regular exercise programmes, talks and workshops, and other activities to support women in ageing successfully.

  7. Council for the Third Age

    Council for the Third Age has resources for helping seniors with lifelong learning. Modules include resources for tech topics, library resources, recommended reading and videos. 

  8. AWWA

    Caregivers Connect is a community network for caregivers by caregivers through events organised each quarter and on online forums. Other services offered by AWWA include a Caregiving Life Skills Training programme.

  9. Tsao Foundation

    The Tsao Foundation has caregiving resources on caring for the frail, looking after your emotional wellbeing and physical health, and financial security, as well as information about TCM and acupuncture.

  10. SG Family Caregivers

    Information about caregiver stress is also available at Singapore Family Caregivers’ website.

It’s the holidays!

It's Christmas!

As the holiday season approaches (well, the school holidays are already here but the adults are still earning their keep with their more-than-9-to-5 lifestyle), it’s not unusual for stress levels to rise. Whether you’re going away for the holidays or staying at home with the family (and possibly extended family), there’s opportunities for tempers to flare, tantrums to be thrown, and arguments to ensue. When it comes to keeping everyone happy, it may be prudent to pre-empt the disagreements:

1. Tips for parents

2. Tips for children

  • With holiday time being also time to revise study material, it’s good to know the best ways to do this. Top tips include giving oneself a quiz, having study goals, leaving you room to rest and engage in other fun activities, finding a good place and good buddies to study at and with.
  • Research also suggests that we remember information best if we process it in depth not superficially. This and other tips are described and explained here.
  • Self-testing and distributing the studying over time are more effective than underlining and re-reading textbook materials: Scientific American explains why.
  • Summarizing material also isn’t the best way to study; but rephrasing study material and explaining things in one’s own words is (Washington Post).

3. Tips for grandparents

  • There’s much research to indicate that engaging in mentally challenging activities has a protective role against dementia. The growth of new neural connections which result from cognitively demanding tasks such as mastering a new language, musical instrument, dance, or skill, are helpful in building cognitive reserves, which not only lowers the risk of Alzheimer’s dementia (AD) but reduces the effects of brain changes relating to AD (Stern, 2012).
  • But puzzles may not be challenging enough: It’s about doing something “unfamiliar” and not “inside your comfort zone” (“Learning new skill beats puzzles for boosting seniors’ memory“, CBS, 21 Oct 2013; APS, 31 Oct 2013).
  • Lifelong learning is one strategy used to build cognitive reserves.
  • Learning programmes which teach seniors new technology like Skype and social media at the Council of the Third Age not only allow learning to take place; the programmes enable seniors to keep engaged and in contact with their families.
  • A Graduate Diploma and Master in Gerontology is available at SIM University for the brave. Their next intake is in July 2014.
  • But if going back to school is not for you, it might be for your grandchildren. Temasek Polytechnic offers the Diploma in Gerontological Management Studies. Their academic year starts late April 2014.